1336138262 NPI number — DR. BERNARD FARZIN MD

Table of content: DR. BERNARD FARZIN MD (NPI 1336138262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336138262 NPI number — DR. BERNARD FARZIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARZIN
Provider First Name:
BERNARD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336138262
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 98978
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89193-8978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-216-3346
Provider Business Mailing Address Fax Number:
702-671-6883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9499 W CHARLESTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89117-7150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-228-5477
Provider Business Practice Location Address Fax Number:
702-255-7981
Provider Enumeration Date:
10/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  D0055075 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 6861 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 13691 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5704 . This is a "CAREFIRST DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: OF31 BR . This is a "CAREFIRST MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 102355 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: MD9996 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080146251 . This is a "RR/MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 162616 . This is a "MEDICARE GROUP ID" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: DS6541 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 2099063 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 889382 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: MDG046 . This is a "MEDICAID GROUP #" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: P01051151 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




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